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Tuesday, June 27th, 2017
Table of Contents

1 Introduction
5 PMID
 [F] Diseases Research  / PubMed Research Articles  /
Eleven-year management of prostate cancer patients on active surveillance: what have we learned?

PubMed

 

Resource

Tumori 2017 Jun 17; ()

Authors

Marenghi C1; Alvisi MF2; Palorini F3; Avuzzi B4; Badenchini F5; Bedini N6; Bellardita L7; Biasoni D8; Bosetti D9; Casale A10; Catanzaro M11; Colecchia M12; De Luca L13; Donegani S14; Dordoni P15; Lanocita R16; Maffezzini M17; Magnani T18; Menichetti J19; Messina A20; Morlino S21; Paolini B22; Rancati T23; Stagni S24; Tesone A25; Torelli T26; Tulli Baldoin E27; Vaiani M28; Villa S29; Villa S30; Zaffaroni N31; Nicolai N32; Salvioni R33; Valdagni R34;

Author Information
  • 1 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 2 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 3 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 4 Division of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 5 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 6 Division of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 7 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 8 Division of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 9 Division of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 10 Division of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 11 Division of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 12 Division of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 13 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 14 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 15 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 16 Division of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 17 Division of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 18 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 19 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 20 Division of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 21 Division of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 22 Division of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 23 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 24 Division of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 25 Division of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 26 Division of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 27 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 28 Division of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 29 Division of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 30 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 31 Division of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 32 Division of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 33 Division of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.
  • 34 Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan - Italy.

Abstract

PURPOSE: To evaluate the outcomes of active surveillance (AS) on patients with low-risk prostate cancer (PCa) and to identify predictors of disease reclassification.

METHODS: In 2005, we defined an institutional AS protocol (Sorveglianza Attiva Istituto Nazionale Tumori [SAINT]), and we joined the Prostate Cancer Research International: Active Surveillance (PRIAS) study in 2007. Eligibility criteria included clinical stage ≤T2a, initial prostate-specific antigen (PSA) <10 ng/mL, and Gleason Pattern Score (GPS) ≤3 + 3 (both protocols); ≤25% positive cores with a maximum core length containing cancer ≤50% (SAINT); and ≤2 positive cores and PSA density <0.2 ng/mL/cm3 (PRIAS). Switching to active treatment was advised for a worsening of GPS, increased positive cores, or PSA doubling time <3 years. Active treatment-free survival (ATFS) was assessed using the Kaplan-Meier method. Factors associated with ATFS were evaluated with a multivariate Cox proportional hazards model.

RESULTS: A total of 818 patients were included: 200 in SAINT, 530 in PRIAS, and 88 in personalized AS monitoring. Active treatment-free survival was 50% after a median follow-up of 60 months. A total of 404/818 patients (49.4%) discontinued AS: 274 for biopsy-related reclassification, 121/404 (30%) for off-protocol reasons, 9/404 (2.2%) because of anxiety. Biopsy reclassification was associated with PSA density (hazard ratio [HR] 1.8), maximum percentage of core involvement (HR 1.5), positive cores at diagnostic biopsy (HR 1.6), older age (HR 1.5), and prostate volume (HR 0.6) (all p<0.01). Patients from SAINT were significantly more likely to discontinue AS than were the patients from PRIAS (HR 1.65, p<0.0001).

CONCLUSIONS: Five years after diagnosis, 50% of patients with early PCa were spared from active treatment. Wide inclusion criteria are associated with lower ATFS. However, at preliminary analysis, this does not seem to affect the probability of unfavorable pathology.



PMID

28623636

Others

Publication Type: Journal Article


This article is licensed under the the National Library of Medicine License. It uses material from the PubMed National Library of Medicine Data.


Last Modified:   2016-03-27


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